Herniated disc

Definition

What is a herniated disc?

A herniated disc, also called a disc prolapse (medical term: discus prolapsus), is a spinal condition in which the soft, gel-like interior of an intervertebral disc (nucleus pulposus) protrudes outward through its outer fibrous ring (annulus fibrosus). The discs sit between the vertebral bodies and act as shock absorbers to cushion impacts and loads. When one or more of these discs are excessively strained, age-worn or damaged, a tear can occur in the annulus fibrosus. As a result, the nucleus can push out and press on surrounding nerves or the spinal cord.

90% of herniated discs occur in the lumbar spine (LS), most often affecting L5/S1 or L4/L5. When a lumbar disc herniation presses on the large sciatic nerve, severe pain can result that radiates from the lower back through the buttock into one leg. About one in ten cases involves the cervical spine (CS) — this is called a cervical herniated disc. Symptoms often radiate into an arm and can include sensory disturbances such as numbness, tingling or even paralysis. Herniated discs in the thoracic spine (TS) are much rarer. In such cases, pain usually appears as a band-like discomfort in the chest area. Sensory disturbances like tingling or numbness in the chest or abdomen, movement limitations or breathing-dependent pain are typical thoracic herniated disc symptoms.

In a disc protrusion (disc protrusion) the disc bulges outward and can press painfully on the spinal cord or a nerve root. The cause is usually a weakened and unstable outer disc ring. Unlike a true herniated disc, the inner nucleus remains entirely within the annulus fibrosus, which is still intact. This is therefore sometimes called an “incomplete” herniation or a possible precursor to a full herniation.

Causes of a herniated disc

A herniated disc is among the most common causes of back pain. The causes of disc herniation are closely linked to changed environmental conditions associated with widely prevalent sedentary lifestyles and lack of daily movement. These factors interact on multiple levels and negatively affect disc health.

Today’s working and living environments differ fundamentally from earlier generations and from our hunter-gatherer ancestors. Technological advances have greatly reduced physically demanding work but also limited natural movement variety. The use of computers, smartphones and automation leads many activities to be performed in static and often unphysiological positions. Most people spend a large portion of the day sitting — whether at the office, during commutes or in leisure time. This persistent static posture causes improper loading of the discs. Furthermore, hard, flat floors and wearing shoes with rigid soles have changed gait patterns and loading of the musculoskeletal system, which also negatively impacts the discs.

In addition to these environmental changes, other risk factors that promote a herniated disc include genetic predisposition, overweight, postural errors and spinal misalignments, smoking and alcohol consumption. The following focuses on the effects of lifestyle changes on the development of herniated discs.

Lack of exercise and a sedentary lifestyle

Modern lifestyles characterized by lack of movement and prolonged sitting cause improper loading of the musculoskeletal system. Physical inactivity and sedentary behavior lead to bodily adaptations that can cause a herniated disc. The following changes significantly contribute to the development of a herniated disc.

• Weakened musculature and muscular imbalances

  Regular movement is essential to strengthen the trunk and back muscles and thereby stabilize the spine. Lack of movement leads to muscle weakening. Weak muscles can significantly increase the risk of a herniated disc. The deep trunk muscles — especially the back and abdominal muscles — play a central role in stabilizing the spine. If these muscles are weak, the spine loses stability and loads are no longer distributed evenly. This increases pressure on the discs, particularly during everyday movements such as lifting, bending or rotating.
  Muscular imbalances — i.e., unequal strength between muscle groups — further exacerbate this effect. For example, if the back extensors are overactive while the abdominal muscles are too weak, poor posture and overload of certain spinal segments occur. This leads to unphysiological movement patterns and can chronically stress the discs.

• Postural faults and overload of the spine

  Prolonged sitting, especially in a forward-bent position or with a rounded back, places asymmetric load on the lumbar spine. This increases posterior pressure on the discs. Over time, due to persistent compression, the disc loses elasticity and becomes less resilient. The nucleus can shift posteriorly through the annulus — precisely where sensitive nerve roots run. If the annulus weakens or tears, a herniated disc may occur.
  

• Reduced blood flow and disc nutrition

  Intervertebral discs, which function as shock absorbers between the vertebrae, rely on good nutrient supply. Reduced circulation — for example from long periods of immobility — can indirectly but significantly promote disc herniation. Although discs are not directly vascularized, they depend on diffusion from surrounding tissues. This passive nutrient exchange only works when the surrounding tissue metabolism is active — which primarily occurs through movement. Movement ensures circulation of blood and lymph, improving exchange of nutrients and waste products around the discs. Prolonged sitting greatly reduces circulation in the pelvic and back regions. As a result, discs receive fewer nutrients and waste products can accumulate — slowing regeneration and making their structure more vulnerable to damage. Over time this disturbed metabolic process can lead to disc degeneration — the annulus becomes porous, the nucleus shifts, and in the worst case a herniation occurs.

• Foot deformities

  The connection between the feet and the back may not be obvious at first glance but is crucial for overall body statics. Through the biomechanical chain, foot deformities such as fallen arches, splay feet, valgus or flat feet can influence the entire body up to the spine. Since the foot is the base of upright gait, static or dynamic deviations immediately affect posture, movement patterns and load distribution in the rest of the body. This can increase the risk of a herniated disc. With a foot deformity, gait patterns change, causing incorrect statics and gait dynamics. Compensatory movements in the knee, hip and pelvis result. The pelvis often tilts slightly forward or to the side, producing unnatural spinal curvatures — for example hyperlordosis or lateral deviation (scoliosis). These postural deviations increase pressure on specific disc segments, particularly in the lumbar region, raising the risk of lumbar disc herniation. Long-term asymmetric loading causes uneven wear of the discs. The annulus may become porous while the nucleus applies increased outward pressure — a condition that predisposes to disc herniation.
  
  Moreover, foot deformities can lead to muscular imbalances, where some muscles become overused while others weaken. This can impair spinal stability and further stress the discs. A healthy foot arch also functions as a natural shock absorber. With deformities, the foot loses this function, so impact forces when walking or running are transmitted unfiltered to the joints and spine. Over time this accelerates disc wear and can cause pain.

• Shortened and tense structures

  Tightened and shortened structures — especially in the back, pelvic and leg muscles — can promote the development of a herniated disc. Lack of movement and predominantly sedentary lifestyles encourage shortening and tension in certain muscle groups. This disturbs muscular balance, causing postural faults and uneven load distribution of the spine and discs. Particularly in the lumbar region, this increases pressure on specific disc segments and raises the risk of lumbar disc herniation.
  
  Short muscles, such as the hip flexors or the hamstrings, also exert persistent pull on the spine and limit its mobility. At the same time, tense back and neck muscles can compress the vertebral bodies unnaturally. This chronic mechanical overload reduces disc nutrition, promotes degeneration and increases the likelihood of a herniated disc.
  

• Fascial dysfunction

  Fascial dysfunctions can contribute to herniated disc development in various ways. Fascia are connective tissue structures that envelop, connect and stabilize muscles, organs and other tissues. If these structures are adhered, hardened or have reduced gliding ability — for example due to lack of movement or chronic poor posture — they lose their elastic and supportive function. This restricts mobility and disturbs muscular coordination, leading to unbalanced movement patterns. This can produce abnormal loading along the spine that increases pressure on certain discs. Furthermore, a tense fascial chain over time can cause compensatory postural changes that disrupt the spine’s natural movement. Consequently, the risk of microtraumatic disc damage rises, favoring the development of a herniated disc.
  

• Joint stiffness

  Joint stiffness — especially in the spine, pelvis or hip joints — can significantly increase the risk of a herniated disc. When certain joints have reduced mobility, the body’s natural movement dynamics are disturbed. Restricted mobility in one area is often compensated by excessive movement in another — frequently the lumbar spine. This compensatory overload causes uneven pressure distribution on the discs, accelerating wear and promoting the development of a lumbar disc herniation.
  
  Additionally, joint stiffness can make everyday movements less fluid and ergonomic. Instead of a springy, even motion, abrupt load peaks occur that can overload the discs. The result: increased pressure on the disc’s inner core, which may be forced out — particularly if the annulus is already pre-damaged or weakened. Thus, joint stiffness indirectly raises the probability of a herniated disc, especially in the lumbar and cervical regions.

Hard, flat floors and inflexible, supportive shoes

Hard, flat floors and inflexible, supportive shoes significantly affect the musculoskeletal system and can promote disc herniation. The following factors play a major role in the development of a herniated disc.

• Hard, flat floors combined with inflexible, supportive shoes can severely impair the body’s natural shock absorption and thus contribute to disc herniation. Normally, the foot — especially the elastic foot arch — along with muscles and the fascial chain act as a biomechanical buffer that cushions shocks when walking or running before they reach the spine and discs. If this natural damping function is lost through prolonged walking on hard surfaces or by wearing rigid shoes, impact forces are transmitted almost unfiltered up the skeletal system with each step. These increased ground reaction forces directly affect the knees, hips and especially the spine — particularly the lumbar region. Mechanical load on the discs increases over time, which can lead to microinjuries, accelerated degeneration of the annulus and ultimately to a disc protrusion or prolapse.
  
  Due to the early and increased force application the reaction time of the stabilizing back muscles shortens. If the muscles do not activate quickly enough to stabilize the spine, uncontrolled loading of the discs occurs. The deep trunk muscles and surrounding structures play a central role in protecting the spine and discs. If this muscular protective function is impaired by delayed activation or weakness, mis- and overloading can occur. In the long run, insufficient muscular damping combined with increased force leads to accelerated disc wear.

• Restricted foot function and muscle weakening

  Wearing shoes with rigid soles or supportive elements and walking on hard, flat floors prevents natural foot motion. The reduced range of motion of the feet leads in the long term to weakening of the relevant foot and leg muscles, which in turn can cause foot deformities and limit the function of the foot arches. This impairs shock absorption, leading to altered load distribution in the legs and spine. Ground reaction forces are then not absorbed by the foot’s damping function but transmitted through the knees and hips to the spine. This increases disc loading and raises the risk of disc prolapse.
  Foot deformities such as fallen arches, splay feet, valgus or flat feet change body statics and can trigger compensatory movement patterns, such as pelvic tilt or unnatural spinal curvature. This increases mechanical load on certain spinal segments and weakens postural control and deep muscles. As a result, muscular imbalances, poor posture and increased pressure on the discs develop.
  A healthy foot function and strong foot musculature are therefore an often underestimated but crucial factor in relieving the spine.
  

• Altered gait and roll-off patterns

  Inflexible shoes and hard, flat floors affect the foot’s natural roll-off. Because of the rigidity of the surface, the ground reaction force after heel strike is transmitted directly to the feet. The responsible muscles in the feet and legs cannot contract adequately due to the increased and rapidly rising force, preventing proper stabilization of the ankle joints. The so-called collapsing foot (toe-drop) can occur, where the foot uncontrollably folds down after heel strike. Forces are thus transmitted unfiltered upwards and the spine and its discs are mis- and overloaded.
  Furthermore, the inflexibility of the surface prevents a natural roll-off over the forefoot. The foot then loses its ability to absorb force elastically for forward motion and to distribute it evenly through the body. This restriction negatively affects the entire muscular and joint chain: the missing or incomplete roll-off reduces activation of foot, leg and trunk muscles and weakens important stabilizers of the musculoskeletal system.

Symptoms of a herniated disc

Symptoms of a herniated disc often depend on factors such as pain sensitivity, causes of the herniation, severity of the injury, physical constitution, etc. In many cases, the symptom pattern can indicate a herniated disc. To obtain a definitive diagnosis, you should consult a physician. An MRI (magnetic resonance imaging) is required for a precise diagnosis of a herniated disc. X-rays are often not conclusive because they do not show soft tissues such as discs or nerves. However, X-rays may provide indirect clues, for example through narrowed intervertebral spaces or changes in the vertebral bodies. The most common symptoms of a herniated disc are listed below. Note that atypical symptoms may also occur and that this list is not exhaustive.

• Back pain: Typical symptoms include local pain in the area of the affected spine, often sharp or pulling, which can worsen with movement or loading.
• Radiating pain: Pain that travels along a nerve into the legs (lumbar herniation) or arms (cervical herniation) arises from nerve root compression (e.g., sciatica). Radiation into one or both legs are typical lumbar herniation symptoms. Radiation into one or both arms are typical cervical herniation symptoms.
• Tingling and numbness: Sensory disturbances such as “pins and needles” or numbness in the arms, hands, legs or feet indicate nerve irritation or compression.
• Muscle weakness: Affected muscles lose strength, which may manifest as stumbling, insecure grip or reduced grip strength.
• Movement limitations: Mobility is often restricted due to pain or neurological deficits — everyday movements become difficult or painful.
• Paralysis (rare but serious): Partial or complete paralysis of certain muscle groups indicates severe nerve compression and must be taken seriously; urgent medical evaluation is required.
• Bladder or bowel dysfunction (emergency!): If nerves controlling bladder or bowel function are affected, loss of control can occur — these symptoms constitute a medical emergency (cauda equina syndrome).
• Sharp pain during loading: Sudden, knife-like pain when lifting, bending or sneezing due to nerve irritation.
• Postural guarding: Patients often adopt an unconscious protective posture to avoid pain — frequently with lateral spinal curvature.
• Muscle tension: Protective tension in back, gluteal or neck muscles leads to hardening and limited mobility.
• Morning stiffness: Many patients report a stiff spine or reduced mobility immediately after getting up.
• Pain when sitting or standing for long periods: Particularly with lumbar herniation, symptoms worsen when sitting, standing long or driving.
• Pain when coughing or sneezing: Increased abdominal pressure further stresses the disc and can cause brief, sharp pain.
• Cold or numb extremities: Disturbed nerve conduction can impair temperature perception in arms (cervical herniation) or legs (lumbar herniation).
• Coordination problems: Especially with cervical herniations, fine motor skills may decline — for example when writing or grasping small objects.
• Gait instability: Unsteady walking or stumbling may result from reduced muscle control or impaired proprioception.
• Reflex loss: Certain reflexes (e.g., patellar tendon reflex) may be absent or diminished in neurological deficits.
• Sensation of “falling asleep” limbs: Frequent paresthesias such as numb feet or hands, even without external cause.
• Exhaustion from chronic pain: Chronic pain leads to physical and mental fatigue and sleep disturbances.
• Headaches or dizziness (with cervical herniation): Irritation or tension in the neck can cause tension headaches or vertigo.

Conventional therapies — what helps for a herniated disc

There are several approaches to treating a herniated disc. The goal should always be to avoid surgery if possible. Some common therapies for herniated discs are described below. The list is not exhaustive and measures are often combined to treat pain and prevent disc surgery. Medical consultation is recommended to determine the most appropriate treatment for a disc prolapse.

• Pain medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac help reduce pain and inflammation. For more severe symptoms, muscle relaxants or corticosteroids may be used.
• Physiotherapy: After diagnostic assessment, targeted exercises improve mobility, strengthen muscles and correct posture. This relieves the spine, reduces relapse risk and alleviates pain.
• Medical training therapy (MTT): Under guidance, strength, endurance and mobility are specifically built up to treat the herniation. A stable trunk musculature protects the spine and discs long-term from overload. Targeted exercises can speed recovery after a herniation.
• Infiltrations / injections: For severe pain, local injections (e.g., corticosteroids or local anesthetics) can be administered close to the nerve root. These reduce inflammation and provide targeted pain relief.
• Occupational therapy / posture training: Occupational therapists help adapt everyday movements. Posture training promotes back-friendly behavior while sitting, lifting and walking and can help prevent lumbar herniation.
• Manual therapy / chiropractic care: Gentle mobilization or manipulation improves spinal mobility and relieves muscular tension. This reduces nerve pressure and can speed recovery after a herniation.
• Pain management / psychosomatic support: Chronic pain can affect mental health. Multimodal programs combine physical and psychological treatments for long-term pain coping.
• Orthopedic aids: Insoles, braces or orthopedic mattresses can relieve the spine and improve posture — especially for foot deformities or muscular imbalances.
• Heat or cold therapy: Heat (e.g., heat patches, paraffin) promotes circulation and relieves tense muscles. Cold is useful for acute inflammation, reducing pain and swelling.
• Naturopathic methods / acupuncture: Acupuncture and other naturopathic methods such as cupping or homeopathy can stimulate self-healing and relieve pain — particularly as complementary measures to conventional treatment.
• Weight reduction: Excess weight places additional strain on the spine and discs. Long-term weight loss can reduce disc pressure, support healing and help avoid surgery.
• Offloading and targeted rest breaks: Short-term physical rest (without complete bed rest) relieves the spine and discs. Loading is then gradually increased with active movement therapy to specifically treat the herniation.
• Back school / prevention programs: In back schools, patients learn back-friendly behavior and movement patterns for daily life. This reduces recurrence and helps keep the spine and discs healthy long-term.
• Disc surgery: If paralysis, persistent pain or bladder/bowel dysfunction occurs, surgery may be necessary. The aim of disc surgery is to remove pressure on the nerves.

Because many of these measures do not permanently resolve the consequences of inactivity, sedentary lifestyles, hard flat floors and inflexible supportive shoes, the accompanying problems of a disc prolapse can often recur. Therefore, every treatment should aim to eliminate these root causes. The kybun mode of action appears to be a suitable therapy to protect and strengthen the spine and intervertebral discs.

kybun mode of action — what helps for a herniated disc

The kybun products aim to eliminate the harmful effects of hard, flat floors and inflexible supportive shoes while actively addressing lack of movement and sedentary behavior. Due to the elastic-springy properties of kybun products, the musculoskeletal system is both unloaded and activated. The unloading reduces the impact forces on the discs and the disc-related pain in the first step. Activation promotes a natural, joint-friendly gait and strengthens the musculature throughout the musculoskeletal system so that complaints become a thing of the past in the long term. Thus, kybun shoes are well suited for herniated discs because they aid treatment through the following mechanisms:

• Promotion of movement and reduction of sedentary activity

  Regular movement and reducing sitting time are central to preventing herniated discs and relieving existing complaints. It is well known that activity has positive effects on back pain and that inactivity often exacerbates symptoms. The elastic-springy kybun products encourage movement because walking and standing on the unique material relieves the spine and surrounding soft tissues. The advantages of increased movement combined with kybun products are outlined below. Using kybun products can also reduce total sitting time and thereby minimize the negative consequences of a sedentary lifestyle.

• Activation and strengthening of muscles via the elastic-springy property

  An elastic-springy surface can specifically promote muscle activation and strengthening, helping prevent herniated discs or relieve current symptoms. When walking and standing on a compliant, slightly unstable surface, the muscles — especially in the feet, legs, pelvis and trunk — must constantly perform small compensatory movements to maintain balance. This continuous, reflexive activation trains the deep stabilizing muscles, which are crucial for spinal stability. In addition to individual muscle groups, intermuscular coordination — the interaction among muscles — improves, optimizing movement control and spinal stabilization.
  Activating the feet directly benefits prevention and treatment of herniated discs. The feet are the base of posture and play a central role in force transmission and shock absorption during walking and standing. A well-functioning foot musculature stabilizes not only the arch but also improves overall body statics and movement coordination.
  When foot muscles are specifically activated, neural control of the deep stabilizing muscles of the entire musculoskeletal system improves. This stabilizes knees, hips and especially the spine. At the same time, an active foot musculature and preserved foot arches reduce peak loads that occur with each step and act on the discs. Moreover, the slow and controlled sinking of the heel into the elastic-springy material activates a myofascial pre-tension in the involved muscles. This pre-tension and improved muscular activity allow the spine to be stabilized and guided earlier, reducing force impact on the discs.

Balance and EMG

Balance ability was measured with a force plate by tracking center of mass movement front-to-back (ant-post) and side-to-side (med-lat) while standing. Simultaneously, an electromyography (EMG) recorded muscular activity.

• Reduction of ground force impact from hard, flat floors via damping effect

  Hard, flat floors transmit direct impact forces through the feet, knees and hips into the spine with every step. These repeated microloads increase disc pressure over time. With heel strike in kybun shoes, the elastic-springy material compresses. This rebound effect of the sole captures part of the forces and can release them again during the roll-off phase. The kybun sole’s force absorption leads to damping that reduces peak loads on joints and discs. Consequently, discs can better perform their function as natural shock absorbers and are less compressed unilaterally or excessively.
  Furthermore, the slow sinking of the heel into the elastic-springy material gives the body more time to tense the relevant muscle groups. Improved baseline muscle tension stabilizes the individual spinal joints and thus reduces force impact on the discs.

• Natural foot roll due to muscle activation and roll-off function

  At heel strike in kybun shoes the elastic-springy material compresses. This slower sinking into the kybun sole delays the moment of maximal force impact. This extra time helps the muscles to tense in time to control the foot placement after heel strike. On the one hand, activating the foot muscles stabilizes the foot arch and thus uses the foot’s shock absorption function. This effective damping protects downstream structures such as the knees, hips and spine because forces during walking and standing are not transmitted unattenuated upward. On the other hand, muscle activation at heel strike prevents the damaging collapsing foot by allowing the foot to transition into a natural roll-off. Active roll-off over the forefoot channels the acting force into forward movement. It also increases the range of motion of the joints above, which ultimately leads to rotation of the torso. Using all joints through their maximal available range distributes loads evenly across the body and relieves the discs. Torso rotation generates movement between individual vertebrae, which nourishes the disc. More on this under “Improved circulation through increased movement activity”.

• Care and protection of the fascia

  Walking on an elastic-springy surface can significantly help protect and care for the fascia — thereby preventing the development of a herniated disc and alleviating existing complaints. Fascia, the connective tissue that envelops and connects muscles, organs and joints, react sensitively to movement — particularly gentle, rhythmic and springy impulses as occur when walking on an elastic-springy surface. Such movement promotes circulation, fluid exchange within fascial layers and removal of metabolic waste, preventing or resolving adhesions and hardening. When fascia are underused or stressed unilaterally — for example because of prolonged sitting or rigid movement patterns — they lose elasticity and gliding ability. This can lead to restricted movement, muscular tension and abnormal spinal loading, increasing herniation risk. Fascial tensions compress the discs toward each other, resulting in compression and overload. An elastic-springy surface encourages more natural, supple movement that mobilizes, preserves and protects the fascial network. When the fascial system is maintained, it can stabilize the spine, distribute pressure evenly and help relieve the discs. This reduces both the risk of prolapse and supports regeneration and pain relief for existing complaints.
  

• Improved circulation through increased activity

  Walking and standing on an elastic-springy surface naturally increases movement, which in turn can significantly improve circulation throughout the musculoskeletal system, including muscles near the spine and indirectly the discs. Better circulation means surrounding tissues — especially muscles, fascia and discs (via diffusion) — receive more oxygen and nutrients. This is crucial because discs lack their own blood supply and rely on movement to absorb nutrients and remove waste. Overall, enhanced circulation through regular activity on an elastic surface supports regeneration, maintenance of disc function and can markedly reduce the risk of a disc prolapse or mitigate the consequences of an existing herniation.
  

• Optimized pressure distribution

  The entire sole of the foot is enveloped by the unique elastic-springy material. This leads to optimized pressure distribution across the feet and reduced peak loads, evenly distributing impact forces over feet, legs and spine. This can reduce focal loading on the discs. Additionally, the constant slight movement on kybun products increases the contact area, further reducing pressure points. Thus, discs can be protected from overload and injury.

Application tips for herniated disc

Before you wear kybun shoes for the first time, consider some usage tips. Correct use can help relieve pain from a herniated disc. Treating a herniated disc should also include targeted therapeutic measures described in the next section.

• Wear kybun shoes initially only for as long as your body tolerates. Introduce wearing breaks if disc pain increases or the musculoskeletal system becomes fatigued. Treatment takes time. Because kybun products are activating, the muscles will be trained and may produce so-called initial reactions, especially at the beginning.
  
• For disc pain, you should primarily reduce walking and standing and shorten sitting duration. Prolonged sitting tends to increase disc-related back pain because pressure on the discs is highest then. Also reduce movements or postures that increase pressure on the affected disc or further irritate the nerve root. It is not uncommon for patients with a herniated disc to report pain when rotating or laterally bending the trunk or when flexing the spine forward.
  
• Actively press the heel into the elastic-springy material at heel strike and feel the damping effect of kybun shoes. The damping is intended to cushion and reduce shocks to the back, thereby decreasing loading on the discs.
  
• If pain is reduced, try to roll off actively over the forefoot. Increasing foot range of motion generates more movement in the back, which helps with tension and blocked segments. If active roll-off is not yet possible due to back pain, reduce forefoot roll-off.
  
• Try the following exercises to enhance the effectiveness of kybun shoes and increase the likelihood of recovery. These are complementary as disc therapies and should be part of the treatment for disc-related pain.

Helpful exercises for a herniated disc

To enhance the effect of kybun shoes and speed recovery after a herniated disc, we recommend the following exercises for disc-related pain. The selection is not exhaustive and can be supplemented with other therapies. In principle, during all exercises, pain around the back must not increase. If any exercise increases pain, it must be stopped. Pleasant and relieving “discomfort” is acceptable.

Exercises are divided into: “Correct walking in kybun shoes”, “Muscle length training”, “Fascia rolling” and “Strengthening”. Ideally these areas are used complementarily as part of disc therapy.

Correct walking in kybun shoes
The quality of each step is critical in treating a herniated disc to reduce pain and eliminate mis- and overload. kybun shoes thus provide an ideal treatment.

Active heel strike

• Press the heel deeply into the elastic-springy material to feel the damping of the kybun sole.
• Maintain controlled foot alignment so the foot does not roll inwards or outwards.
• Place mid- and forefoot in a controlled manner to reduce force impact on the body.

Active foot roll-off

• Actively roll off over the forefoot using the maximal available range of motion.
• Using the maximal range is important so that physiologic pelvic-to-spine rotation occurs.
• If symptoms recur with spinal rotation, the roll-off should be reduced.

Muscle length training
Muscle length training is crucial in treating a herniated disc because the herniation and subsequent pain often result from shortened, tense and blocked myofascial structures. Targeted stretching can address these issues and are therefore an ideal disc therapy.

Hip opener

• Start in a quadruped position.
• Place the left foot forward next to your hands.
• Extend the right leg backward and place the foot flat. Ensure hip and spine are aligned.
• To intensify the stretch, press the hip forward and down depending on individual mobility.
• Perform 1–2 × daily.
• Hold the exercise for 3 × 30 seconds.

Anterior thigh (quadriceps) stretch

• From standing, grasp the top of the left foot with the left hand. For balance, hold a stable object with the right hand if needed.
• Left thigh should be parallel to the supporting leg.
• Keep a straight back.
• Tilt the pelvis slightly forward to increase the stretch in the thigh.
• Pull the heel toward the buttock so the knee points downward. The closer the heel to the buttock, the stronger the stretch.
• Perform 1–2 × daily.
• Hold 3 × 30 seconds.

Fascia roller
Fascia rolling is important for treating disc pain, as they often result from shortened, tense and blocked myofascial structures. Regularly rolling out shortened and tense myofascial chains makes the fascia roller an active disc therapy.

Gluteal muscles

• Bend both legs and roll the corresponding half of the gluteal area with a fascia ball. Increase pressure by placing one leg on top of the other. If wrist pain occurs, perform the exercise on the forearms.
• Perform the exercise slowly and controlled.
• Adjust pressure to personal tolerance, but go up to a tolerable pain threshold.
• For focal adhesions, roll more intensely or hold the position at that point.
• 3 minutes per side.
• Perform 1–2 × daily.

Anterior thigh (quadriceps)

• Start prone.
• Place a large roller under the thigh of the extended leg. Place the other leg bent to control movement.
• Roll the anterior thigh actively from the hip to above the knee.
• Perform exercises slowly and controlled. Adjust pressure to personal tolerance but remain within a tolerable pain limit.
• For focal adhesions, roll more intensively or hold position at that point.
• 3 minutes per side.
• Perform 1–2 × daily.

Strengthening
Targeted strength training helps stabilize the trunk and thus unload the spine, which is essential for treating herniated discs. Strengthened muscles can better absorb forces acting on the discs during movement. Muscles also stabilize individual joints and protect them from mis- and overloading. Strengthening exercises are an effective disc therapy and contribute to long-term pain relief.

Bird-dog (quadruped)

• Start in a quadruped position.
• Place hands shoulder-width under the shoulders and knees hip-width under the pelvis.
• Extend the right leg backward and the left arm forward.
• Keep a straight and stable spine.
• Then bring the right leg and left arm together and extend them again.
• 3 sets of 8–12 repetitions.
• Perform 2–3 × weekly.

Bridge

• Start position: supine with knees bent (hip-width). Arms are extended shoulder-width toward the feet.
• Actively lift the hips off the floor toward the ceiling (the hips should be fully extended at the top of the movement).
• Hold the top position for 4 seconds.
• Ensure the force comes from the glutes (not from the heels or posterior thighs).
• Lower the hips slowly, without the glutes touching the floor.
• 3 sets of 8–12 repetitions.
• Perform 2–3 × weekly.